Horton Cross Nursing Home

Updated 13 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by two inspectors.

Service and service type

Horton Cross Nursing Home is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Horton Cross Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post as they had resigned shortly before the inspection. The provider had appointed a new manager who planned to register with the Care Quality Commission.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, this included notifications made by the service and concerns raised with the Care Quality Commission. We sought feedback from the local authority quality assurance team and safeguarding team, as well as other health and social care professionals. We used all of this information to plan our inspection.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We met all of the people who lived at the service and spoke with 14 people about their experience of the care provided. We also spoke with 3 family members to get their view of the service. We observed people and staff in the communal areas throughout the day.

We spoke with 18 members of staff including the nominated individual for the service, care and nursing staff, agency staff, the general manager, maintenance person, chef and catering staff, and housekeeping staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of care records. This included a full review or partial review of 6 people's care records and several medication records. We looked at 2 staff files in relation to recruitment and staff supervision.

A variety of records relating to the management of the service, including policies and procedures, maintenance records, cleaning schedules, staff rota's, monitoring charts, fire documents and external servicing records were reviewed.

We asked the service manager to email a Care Quality Commission inspection poster to all relatives and staff, inviting them to share their experiences either through our website or by phone. We received comments from four staff members and two relatives in response to this.

Updated 13 January 2024

About the service

Horton Cross Nursing Home is a care home registered to provide care and accommodation for up to 47 people. The home specialises in the care of older people. At the time of the inspection there were 37 people living at the service.

People’s experience of using this service and what we found

During the inspection several concerns were identified and shared with the provider. The provider did not have effective oversight of the care provided and the running of the service. Repeated breaches of the regulation linked to safe care and treatment and good governance indicate lessons were not being learnt by the provider. This meant they also failed to implement improvements at the service in a timely manner.

People did not always receive safe care and treatment. Risks and care needs were not always identified and actions to lessen risks not taken.

People did not always have their clinical needs met effectively. Instructions from health professionals was not always followed leaving people at risk of further health complications.

People did not always receive care that was personalised to their individual needs. The provider had not always ensured staff on duty were sufficiently qualified, competent, skilled, and experienced. This impacted on the quality of care delivered to people.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The practice and systems in the service did not support this practice. We have made a recommendation as care plans for people living with dementia did not always contain records of best interest decisions in relation to where and how people spent their time. We observed several people spent all day or long periods in bed or in their room. However, records did not contain information about how these decisions were made.

The provider took the concerns found during the inspection seriously and will work alongside CQC and other agencies to address the issues. The provider developed an action plan following the inspection to address the shortfalls found.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 October 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommendations the provider monitor the storage temperatures for all medicines and make improvements were required to the environment, including access to bathing and showering facilities. We found action had been taken to address the recommendations.

Why we inspected

The inspection was prompted in part due to concerns received about how people's needs were being managed. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing deployment, person centred care, and governance.

We have taken enforcement action requiring the provider to ensure the robust and effective management and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.